Wolters Kluwer Health may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
your express consent. For more information, please refer to our Privacy Policy.

Read breaking news and articles published ahead of print. Tell us what you think and comment on your colleagues’ views about EMN articles.

Monday, July 07, 2014

RADiUS to the Rescue for Patients with SOB

By Christine Butts, MD

We have been taking a close look at the RADiUS protocol for the past several months, but now it’s time to put all of the pieces of the protocol together in assessing patients. RADiUS — rapid assessment of dyspnea with ultrasound — evaluates the heart, IVC, pleura, and lung parenchyma. It is a useful bedside tool for quickly assessing patients with undifferentiated shortness of breath, an extremely valuable tool for emergency physicians. These patients are challenging and require speedy appraisal and treatment.

A 60-year-old man is brought to the ED by EMS complaining of shortness of breath for a past day. EMS has little history, but carries a bag of the patient’s medications, which includes two inhalers, a diuretic, and an ACE inhibitor. The patient is in some distress, and is only able to speak a word or two at a time. His blood pressure is 180/90 mm Hg, heart rate is 120 bpm, respiratory rate is 40 bpm, and SpO2 is 80%. He is obese, and his breath sounds are diminished throughout but no wheezing is noted. He has questionable edema to his lower extremities, although his size makes this difficult to assess.

Finally, evaluation of the lung parenchyma shows the presence of diffuse bilateral B-lines (Image 2), consistent with the interstitial syndrome.

Putting all of these findings together gives a likely diagnosis of cardiogenic pulmonary edema, allowing the EP to initiate the correct treatment pathway rapidly. It also enables the EP to rule out other life-threatening causes of dyspnea, such as pericardial effusion.

Dr. Butts is the director of the division of emergency ultrasound and a clinical assistant professor of emergency medicine at Louisiana State University at New Orleans. Follow her @EMNSpeedofSound, and read her past columns at http://bit.ly/ButtsSpeedofSound.